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. 2018 Feb 23;18(1):59.
doi: 10.1186/s12877-018-0750-2.

Variation of polypharmacy in older primary care attenders occurs at prescriber level

Su Miin Ong  1 , Yvonne Mei Fong Lim  2 , Sheamini Sivasampu  2 , Ee Ming Khoo  3
Affiliations

Variation of polypharmacy in older primary care attenders occurs at prescriber level

Su Miin Ong et al. BMC Geriatr. .

Abstract

Background: Polypharmacy is particularly important in older persons as they are more likely to experience adverse events compared to the rest of the population. Despite the relevance, there is a lack of studies on the possible association of patient, prescriber and practice characteristics with polypharmacy. Thus, the aim of this study was to determine the rate of polypharmacy among older persons attending public and private primary care clinics, and its association with patient, prescriber and practice characteristics.

Methods: We used data from The National Medical Care Survey (NMCS), a national cross-sectional survey of patients' visits to primary care clinics in Malaysia. A weighted total of 22,832 encounters of patients aged ≥65 years were analysed. Polypharmacy was defined as concomitant use of five medications and above. Multilevel logistic regression was performed to examine the association of polypharmacy with patient, prescriber and practice characteristics.

Results: A total of 20.3% of the older primary care attenders experienced polypharmacy (26.7%% in public and 11.0% in private practice). The adjusted odds ratio (OR) of polypharmacy were 6.37 times greater in public practices. Polypharmacy was associated with patients of female gender (OR 1.49), primary education level (OR 1.61) and multimorbidity (OR 14.21). The variation in rate of polypharmacy was mainly found at prescriber level.

Conclusion: Polypharmacy is common among older persons visiting primary care practices. Given the possible adverse outcomes, interventions to reduce the burden of polypharmacy are best to be directed at individual prescribers.

Keywords: Epidemiology; Medication; Multilevel modelling; Multimorbidity.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval for this study was granted by the Medical Research and Ethics Committee of the Ministry of Health Malaysia (NMRR-09-842-4718). All records were anonymised before use in the analysis.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Types of medications used in patients with polypharmacy by sectors
Fig. 2
Fig. 2
Variation in rate of polypharmacy between public practices and between prescribers within public practices
Fig. 3
Fig. 3
Variation in rate of polypharmacy between private practices. Error bars denote 95% confidence intervals for the residuals
See this image and copyright information in PMC

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